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File 40 Chronic Diseases asthma adult and child Chronic asthma (adult & child) Recommend Promote the avoidance of trigger factors along with drug management for prevention and treatment with a goal of no regular wheeze or cough Background Asthma in children differs from asthma in adults in clinically important aspects, which include the patterns of asthma, natural history and anatomical factors. The pattern and severity of asthma in childhood vary widely [1] Related Topics: Acute asthma, page 70 1. May present with: Diagnosis of asthma Symptoms may be seasonal and recurrent, worse at night and have obvious triggers. Signs include: wheeze on chest auscultation hyper-inflated lungs spirometry showing reversible airflow limitations 2. Immediate management – see Acute asthma 3. Clinical assessment: Obtain complete patient history family history of asthma, allergies or other risk factors history of symptoms and triggers medication history Perform standard clinical observations + perform spirometry (FEV1) or peak expiratory flow (PEF) in children over 7 years Perform physical examination including: auscultate chest for air entry and wheezes Considerations should be given to the causes of wheeze in young children [1] Condition Characteristics Transient infant wheezing Onset in infancy No associated atopy Associated with maternal smoking Cystic fibrosis Recurrent wheeze and failure to thrive Inhaled foreign body Sudden onset Milk aspiration / cough during feeds Especially liquids Associated with developmental delay Structural abnormality Onset at birth Cardiac failure Associated with congenital heart disease Suppurative lung disease Early morning wet / moist cough File 40 Chronic Diseases asthma adult and child 4. Management Ensure correct use of bronchodilator medication and / devices -check inhaler technique Avoidance of trigger factors determine triggers - common trigger factors include animal hair, pollens, dust, cold air, physical activity, viral upper respiratory tract infections Families of people with asthma are particularly encouraged to cease smoking / not smoke around person with asthma Asthma plans asthma plans work on the principle of stepping up and stepping down treatment according to symptoms. They should indicate when to introduce and remove treatments and when to ask for help. Patients should be encouraged to be responsible for their illness Encourage use of peak flow meters to monitor asthma progress Educate the patients / carers of children about: ‘treaters’ and ‘preventers’, triggers Management aims Achieve and maintain control of symptoms Maintain normal activity levels including exercise Maintain pulmonary function as close to normal as possible Client and family manages asthma Prevent exacerbations Avoid adverse effects from asthma medications Prevent asthma mortality [2] DTP IHW / NP Authorised Indigenous Health Workers must consult MO and supply under the conditions of the DTP Nurse Practitioners may proceed Route of Recommended Form Strength Duration Administration Dosage Tablet/ As ordered Oral As ordered by MO As ordered by MO Inhaler by MO Short Acting B2 Agonists Inhaled corticosteroids Salbutamol (S3) Beclomethasone Budesonide Budesonide Fluticasone Propionate Long Acting B2 Agonists Salmeterol Combination Iihalers Eformoterol Budesonide/Eformoterol Fluticasone/Salmeterol Anticholinergics Ipratropium Theophylline Tiotropium Theophylline SR Schedule 4 Respiratory Medication Oral corticosteroids Prednisolone Management of Associated Emergency: Consult MO File 40 Chronic Diseases asthma adult and child 5. Follow up: Asthma 4 x 4 First Aid 4 puffs of reliever (blue) medication through a spacer give one puff at a time ask the person to take 4 breaks from the spacer after each puff wait 4 minutes if there is no improvement give another 4 puffs if little of no improvement call an ambulance / health centre immediately. Keep giving 4 puffs every 4 minutes until help is obtained [1] Further follow up according to current edition Chronic Disease Guidelines Queensland Health and RFDS (Queensland Section) or local protocols if outside Queensland 6. Referral / Consultation: All children / adolescents with asthma should be reviewed by a MO Children and adolescents with severe asthma require specialist referral According to Queensland Health current edition Chronic Disease Guidelines or local protocols if outside Queensland References 1. 2. National Asthma Council Australia, Asthma Management Handbook. 2006, National Asthma Council: South Melbourne. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. 2008 [cited 6/4/09]; Available from: http://www.ginasthma.org.